Innovation case study: Oxygen-wristband pilot

An award-winning and novel invention that has the potential to save lives in hospitals throughout the country

Friday, May 6, 2016

Front-line clinicians at Derby Teaching Hospitals NHS Foundation Trust have developed a system of colour-coded silicone wristbands which state the patient’s target saturation range, designed to ensure the correct level of oxygen is prescribed

Oxygen is the most commonly used drug in acute hospitals and misuse contributes to up to 4,000 avoidable deaths per year in chronic lung disease

We speak to Dr. Gillian Lowrey, Respiratory Consultant Physician at Royal Derby Hospital, about what prompted the study, the process of putting it into action, and how her understanding of innovation changed in the process

Welcome to Respiratory Futures, Gillian. Could you give us an overview of what the oxygen wrist bands do?

The wristbands provide a visual prompt for staff as to the individual patient’s target saturation whilst in hospital. The bands are colour-coded to help staff titrate oxygen to the correct range, limiting oxygen toxicity but also under oxygenation, both of which can cause harm to patients.

What motivated you to set this system up, why is it so important?

I see patients who are harmed with the misuse of oxygen on a weekly basis. During the course of the last 5 years things such as electronic prescribing have come along, but this hasn’t always made things better. E-prescribing can mean the HCA (who check patients' observations) don’t have easy access to the prescribed target saturation at the beside. The wristbands make it clear to the people who are measuring the oxygen saturation - as well as the patient - what oxygen level is safe for them.

Prescription and titration of oxygen improved from 64% to 98%

What difference are you trying to make, and what will success look like for you?

The wristbands are not the whole answer but they help raise the profile of the issue and have improved matters in the pilot sites. Success would be to know we are no longer harming patients with oxygen, with a non-invasive, simple solution.

What response have you had to the pilot?

I'm pleased to say that there has been great feedback from both patients and staff. Two out of the three pilot sites showed prescription and titration of oxygen improved from 64% to 98% and 76% to 94% but the best thing has been the enthusiasm of staff.

The staff surveys from the pilot sites found that 86% of staff felt the wristbands added benefit to patient care. Staff commented that the wristbands provided a simple, effective tool for patient safety, and highlighted the importance of the correct oxygen therapy. Others commented that they were an good visual prompt for healthcare staff.

Have you had any surprises during its development to date?

I think the main surprise has been that lots of patients have really embraced this and it has given them the confidence to question health professionals about oxygen therapy. 72% of patients surveyed said they would continue to wear the wristband after discharge; over half found that wearing the band reassured them about oxygen safety and improved their understanding.

Can you explain a bit about your background and what led you to work on the project?

When I was first appointed as a new consultant it was at the same time the BTS published emergency oxygen guidelines, bringing in the target saturation based approach. As the "new girl" I got the job of implementing them across the Trust! Now I would know better, but I happily said yes to the project back then. It should be such a simple thing to get right, but making change in the NHS is difficult.

The wristband project is just one of the many things we tried to help change and improve oxygen safety and prescription. The inspiration for the bands came when charity wristbands were everywhere and I was getting disheartened at lack of progress, then we realised that they seemed to provide a simple solution for the oxygen problem.

What has been the biggest hurdle you've navigated so far, and do you foresee more challenges and opportunities ahead?

Navigating our way through the systems and committees on multiple Trust sites was the biggest hurdle. This meant changing the band colours and making sure the guidelines were the same everywhere; it wasn’t easy. The project had to be approved at each of the hospitals’ safety committees, and each site had slightly different structures for approval, however the clinicians involved were all very enthusiastic and helped push the idea though.

Hopefully we have demonstrated that innovation doesn't have to be about reinventing the wheel, and that using on-the-ground experience can be the most valuable tool.

We have also managed to do a smaller pilot at my hospital (Derby) which showed success and resulted in us winning the East Midlands Innovation award. This helped considerably in breaking down barriers and meant I had help and resource from the East Midlands Academic Health Science Network and East Midlands Respiratory programme.

The next challenge is spreading the word and making it work on a larger scale. There is an opportunity to improve the prescription and titration of oxygen in acute care and potentially reduce harm, but the wristbands alone will not achieve this. For this to happen we really need to change the culture around the use of oxygen in acute care, new guidelines from the BTS will certainly help, but it’s the front-line staff that need to reinforce these changes.

Do you have any messages or advice for similarly innovative respiratory clinicians?

I don’t really think of myself as an innovator in the traditional sense. My advice is keep things simple, change it locally first and show it works. Hopefully we have demonstrated that innovation doesn't have to be about reinventing the wheel, and that using on-the-ground experience can be the most valuable tool. We took something that was being used in another context – wristbands to raise awareness of charitable causes – and gave it a new purpose.

I'd encourage clinicians not to be shy about shouting about your success, winning prizes can really help. Out of desperation to carry on I put this project forward for the East Midlands Academic Health Science innovation award. The project won (picture: Peter Maleham, Priya Daniels, Sue Smith, Gillian Lowrey and Zenn Athar) and the profile and funds that gave me as a result has helped to move this project forward.

Having worked on the project, how do you define innovation and has your understanding of the concept changed?

People keep asking me that… I don’t really know: taking an idea and putting that idea/change into practice to have a positive benefit to patients. I always thought innovation was high-tech and expensive, but simple low cost things, like the wristbands, can be innovative too.

The wristbands don’t replace anything currently, they work alongside current systems within the acute care setting (such as e-prescribing) to improve patient safety. Their real benefit is their simplicity and low cost.

Thank you, Gillian, and good luck for the future of the project.

Access key resources relating to oxygen therapy, in both emergency and domiciliary settings, and examples of good practice on our dedicated oxygen programme area.

You can find out more about the oxygen wrist-band pilot here, and if you have a similar innovation case study to share, please get in touch.